Homeless health

At any one time, hundreds of people who do not have a home sleep rough in the capital. Over the course of a year that means around 8,000 people. Numbers have doubled since 2009/10. Of all people sleeping rough in the UK, about a quarter are in London.

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Background

Although the term ‘homeless’ is often applied in everyday language to people who sleep rough, there are much broader definitions covering anyone who does not have a home. This includes people whose accommodation is insecure; those facing eviction, living in temporary accommodation, squatting, people at risk of violence, those housed in property potentially damaging to their health, and those who cannot afford their current accommodation. The London Assembly estimates that there as many as 13 times more people are homeless but hidden than are visibly sleeping rough in the capital. Our work is designed to support the NHS to identify and respond to the needs of people who are homeless, by commissioning and providing easy access to health care in community settings; supporting safe hospital discharge and directing people to services where they can get help with their housing needs.

Our vision

Every homeless person should receive care that is consistent in quality and experience with that of the general population and health services should make adjustments to meet the specific needs of homeless people. Systems which support homeless people are linked up as much as possible to improve communication and outcomes as people move around the capital.

Key London challenges

Over the course of a year some 8,000 people sleep rough in the capital. Although numbers have levelled off in the last year, the numbers are double what they were in 2009/10. The term ‘homeless’ is often applied in everyday language to people who sleep rough, however there are also broader definitions covering anyone who does not have a home. The number of people experiencing these other types of homelessness has also grown in London.

Homelessness may be a consequence of health problems, and is very commonly a cause of worsening health. The wellbeing of people who are homeless is at significant risk, especially those who live and sleep on the street. Many people who sleep rough will have significant needs in relation to physical health, mental health and substance misuse.

Current systems of healthcare struggle to meet their needs. Homeless people are more likely to die young, with an average age of death of 47 for men and even lower for homeless women at 43. A recently published international study identifies that that the mortality rate among social excluded groups including homeless people was nearly eight times higher than the population average for men and nearly 12 times higher for women.

Homelessness is a growing and significantly greater problem in London than elsewhere in England and recent studies have identified the impact this population can have on the system:

In cost terms, homeless individuals use eight times more hospital inpatient services than other people of similar age, and are more likely than members of the general public not to be registered with a GP.

Of a sample of the homeless population, half of total acute care costs were incurred by 10% of people.

This demonstrates that quality of life could be improved for this population group by earlier intervention and pro-active services as well as financial savings by changing the model of care. Vulnerability is a key issue in homeless services: both for service users themselves, such as being victims of violence and/or the lack of engagement with, and understanding from, mainstream services; and the often short-term funding for service providers. Furthermore, homeless people and rough sleepers are transitory, and so the issue is necessarily London-wide and more needs to be done with our partners, such as local government, to link programmes across London and mainstream services.

Despite affecting a relatively small population, homelessness is growing and reaches right across health, public health, social care and into related areas such as housing and the justice system.

If you would like more information about our work then please do get in touch at steven.pidgeon@nhs.net